Provider Demographics
NPI:1306258033
Name:BENSMAN-CORREA, SHANI DARA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHANI
Middle Name:DARA
Last Name:BENSMAN-CORREA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHANI
Other - Middle Name:DARA
Other - Last Name:BENSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3421 W PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3736
Mailing Address - Country:US
Mailing Address - Phone:414-526-9386
Mailing Address - Fax:
Practice Address - Street 1:1818 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1003
Practice Address - Country:US
Practice Address - Phone:847-245-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical